For physicians, training area impacts early spending in practice

Physician spending habits can be learned, but they also can change, a study found. In the first years of practice, residency spending patterns had the greatest impact on expenditures per patient, according to a study published in the Dec. 10 issue of JAMA.

In an attempt to understand what drives physician decision-making on spending habits, Candice Chen, MD, MPH, of the Milken Institute School of Public Health at George Washington University in Washington, D.C., and colleagues compared current practice location, length of time in practice, and where physicians studied. They used Medicare Part A and Part B data compared against the American Medical Association Physician Masterfile.

The research team was able to determine whether physicians were trained or currently practiced in high-, average-, or low-spending hospital referral regions. Additionally, they performed further analysis by how long physicians had been in practice, grouping them by one to seven years, eight to 15 years, or 16 to 19 years in practice. They did not, however, assess spending by specialty.

Physicians spent a mean total of $8,262 per Medicare beneficiary across the sample.

They found that many physicians practiced in the same type of spending environment that they trained in: 51.2 percent of physicians who trained in a low-cost region practiced in one, while 69.6 percent who trained in high-cost areas practiced in a high-cost area. Very few physicians sampled trained in low-spending settings and practiced in high-spending ones or vice versa.

Individually, physicians who trained and practiced in areas considered high-cost spent an additional $1,926 per patient per year compared to colleagues who trained at low-spending settings but worked in high-spending ones.

In the first seven years of practice, a 29 percent difference existed between those who trained in high- vs. low-spending settings, a difference of nearly $3,000. The longer they were in practice, however, the fewer differences were noted. By 16 to 19 years of practice, the difference between high-spending and low-spending training regions was only around $956 per patient per year.

Chen et al noted that this study suggested “a need to reconsider findings of geographic imbalances in Medicare GMS [graduate medical education] funding.”

“GME training disproportionately occurs in higher-spending regions so that communities will tend to recruit graduates potentially imprinted with higher spending habits,” they wrote.

They suggested considering training models that expose them to less costly care early in their career to assist in reducing spending among all areas.